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General NPI Number Information
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NPI Number | 1285679597
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Entity Type | Organization
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Legal Business Name | BEAR CREEK NURSING CENTER, LLC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 8041 STATE ROAD 52
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City | HUDSON
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State | FL
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Zip | 34667-6726
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Country | US
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Telephone | 727-863-5488
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Fax | 727-862-9558
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Provider Business Mailing Address
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Address Line | 8041 STATE ROAD 52
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City | HUDSON
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State | FL
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Zip | 34667-6726
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Country | US
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Telephone | 727-863-5488
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Fax | 727-862-9558
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARIA A OWENS-WICKER
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Credential | NURSING HOME ADMINIS
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Telephone | 727-863-5488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF10460962
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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